Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia.
Neurol India. 2022 Mar-Apr;70(2):664-669. doi: 10.4103/0028-3886.344680.
Endoscopic third ventriculostomy (ETV) is a procedure that involves devising an opening in the third ventricle floor, allowing cerebrospinal fluid to flow into the prepontine cistern and the subarachnoid space. Third ventricular floor bowing (TVFB) serves as an indicator of intraventricular obstruction in hydrocephalus and existence of pressure gradient across third ventricular floor, which is the prerequisite of a successful ETV.
In this systematic review and meta-analysis, we aimed to synthesize the latest evidence on the TVFB as a marker for surgical success in patients undergoing ETV.
We performed a comprehensive search on topics that assesses the association of TVFB with the surgical success in patients undergoing ETV from several electronic databases.
There was a total of 568 subjects from six studies. TVFB was associated with 85% (81-88%) ETV success. TVFB was associated with OR 4.13 [2.59, 6.60], P < 0.001; I: 6% for ETV success. Subgroup analysis on pediatric patients showed 86% (82-91%) success rate. In terms of value for ETV success compared to ETV Success Score (ETVSS), a high ETVSS does not significantly differ (P = 0.31) from TVFB and TVFB was associated with OR 3.14 [1.72, 5.73], P < 0.001; I: 69% compared to intermediate/moderate ETVSS. Funnel plot analysis showed an asymmetrical funnel plot due to the presence of an outlier. Upon sensitivity analysis by removing the outlier, the OR was 3.62 [2.22, 5.89], P < 0.001; I: 0% for successful surgery in TVFB.
TVFB was associated with an increased rate of successful surgery in adults and children undergoing ETV.
内镜第三脑室造瘘术（ETV）是一种在第三脑室底部设计开口的程序，使脑脊液能够流入脑桥前池和蛛网膜下腔。第三脑室底凹陷（TVFB）是脑积水患者脑室内部梗阻和第三脑室底压力梯度存在的指标，这是 ETV 成功的前提。
在这项系统评价和荟萃分析中，我们旨在综合最新证据，探讨 TVFB 作为 ETV 患者手术成功的标志物。
我们从几个电子数据库中全面搜索了评估 TVFB 与 ETV 患者手术成功率之间关系的主题。
共有来自 6 项研究的 568 名患者。TVFB 与 85%（81-88%）的 ETV 成功相关。TVFB 与 OR 4.13[2.59,6.60]，P<0.001；I：6%的 ETV 成功率。对儿科患者的亚组分析显示，成功率为 86%（82-91%）。在 ETV 成功率与 ETV 成功评分（ETVSS）的比较中，高 ETVSS 与 TVFB 没有显著差异（P=0.31），而 TVFB 与 OR 3.14[1.72,5.73]，P<0.001；I：69%与中等/中度 ETVSS 相比。漏斗图分析显示，由于存在异常值，漏斗图不对称。通过去除异常值进行敏感性分析后，OR 为 3.62[2.22,5.89]，P<0.001；I：0%的 TVFB 患者手术成功。
在接受 ETV 的成人和儿童中，TVFB 与手术成功率的提高相关。
